Patient Access Account Specialist

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Under the direction of the Patient Access Supervisor, the Patient Access Account Specialist I provides basic functions to financial clear patient accounts for government and commercial accounts prior to the date of service. Performs basic financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, and pre-service collections. The Patient Access Account Specialist I will ensure follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions until date of service or discharge for admissions. The Patient Access Account Specialist I must possess a basic knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access to include HIPAA, EMTALA, and CMS guidelines of MSPQ. The Patient Access Account Specialist (PAAS I) monitors work queues for financial clearance and missing authorizations ensuring a payment source is identified and secured and there is a clean claim for billing. The Patient Access Account Specialist I acts as resource to all employees within Patient Access. The Patient Access Account Specialist I is responsible for providing the highest level of customer service to patients, ancillary departments and payers when financially clearing accounts. The PAAS I will work with ancillary departments to ensure the procedures scheduled and authorized meet payer requirements. The Patient Access Account Specialist I provides coverage to other areas and hospitals as needed to minimize overtime and guarantee the patients receive services as needed without registration delays.

Some key responsibilities include:

• Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
• Ability to manage conflict and appropriately request the help of a supervisor when needed.
• Implement PROMISE and CARES behaviors in every encounter.
• Educates patients for whom they speak regarding insurance benefits and liabilities.
• Ensures accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters
  Encounter Components:
• Performs the patient registration process. Manage the accurate collection of patient data which includes but is not limited to;
• Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled accounts.
• Review Urgent/Emergent admission accounts for notification, financial clearance and authorization pre-discharge.
• Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account.
• Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly.
• Review and process work queues related to Patient Access pre-visit or urgent/emergent admissions, per department guidelines.

Qualifications:

• High school diploma, continued education preferred
• External and Internal Non-Patient Access Candidates: Pass Patient Academy with passing score of 85% or higher
• Previous completion and passing of Patient Access Advocate II and III Advancement test.
• A minimum of 2 years of work experiences in healthcare setting within Patient Access and/or billing plus strong customer service background.
• Strong knowledge and understanding of insurance and financial processing of accounts.
• Proficient in EPIC ADT system
• Specialty Certifications: CHAA, CHAM or other industry equivalent certification preferred
• Pass annual competency exam for all areas of responsibility.
• Requires general knowledge of the customer encounter process which may include registration, contract requirements, and coordination of benefits.
• Knowledge in Microsoft Office Products.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.